§ 367-O — Health insurance demonstration programs

New York § 367-O

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

§ 367-o. Health insurance demonstration programs. 1. Notwithstanding\nany inconsistent provision of law, the commissioner of health is\nauthorized to establish one or more demonstration programs for the\npurposes of providing additional knowledge and experience in mechanisms\nto provide, maintain or subsidize health insurance coverage for\nunemployed and underemployed health care workers.\n 2. Health insurance continuation demonstration. (a) The commissioner\nof health is hereby authorized to establish mechanisms to improve the\nprocess of authorizing medical assistance payment of health insurance\npremiums, pursuant to paragraph (c) of subdivision one of section three\nhundred sixty-seven-a of this title, on behalf of personal care and home\nhealth care workers who reside in any city with a population of one\nmillion or more and any county with a population of nine hundred\nthousand or more if such city or county is located within the\nmetropolitan commuter transportation district created pursuant to\nsection twelve hundred sixty-two of the public authorities law, and\nwhose employment is irregular, episodic, or cyclical, and whose health\ninsurance coverage therefore is frequently disrupted. Notwithstanding\nthe provisions of section three hundred sixty-five of this title, the\ncommissioner of health shall exercise discretion to determine whether\nmedical assistance payment of such premiums is cost effective. If the\ncommissioner of health determines that the test of cost effectiveness of\ninsurance premiums is based on other than a case-by-case basis, no\nmedical assistance payment for such premiums will be made until the\ncommissioner of health obtains all necessary approvals under federal law\nand regulation to receive federal financial participation in the costs\nof such medical assistance.\n (b) The commissioner of health is authorized in consultation with the\nsuperintendent of financial services to require group health insurance\nplans and employer-based group health plans to report to the department\nor its designee, insofar as such reporting does not violate any\nprovisions of the federal Employee Retirement Income Security Act of\n1974 (ERISA), at such times and in such manner as the commissioner of\nhealth shall decide, any information needed to operate such a\ndemonstration project, including, but not limited to, the number of\npersons in such plans who become ineligible each month for the\ncontinuation coverage described in paragraph (a) of this subdivision. In\naddition, every health maintenance organization certified under article\nforty-four of the public health law and every insurer licensed by the\nsuperintendent of financial services shall submit reports to the\nsuperintendent and to the commissioner of health in such form and at\nsuch times as may be required to implement the provisions of this\nsubdivision.\n 3. Rate incentive demonstration. With respect to a demonstration\nprogram authorized by subdivision one of this section, the commissioner\nof health may solicit and accept applications for participation in the\ndemonstration program from any employer, or group of employers, of\npersonal care workers or home health workers, who are employed in any\ncity with a population of one million or more and any county with a\npopulation of nine hundred thousand or more if such city or county is\nlocated within the metropolitan commuter transportation district created\npursuant to section twelve hundred sixty-two of the public authorities\nlaw, and whose employers provide services primarily to medical\nassistance recipients, if the following conditions are met:\n (a) at least fifty percent of the persons receiving services from such\nemployers are recipients of medical assistance;\n (b) the employer contributes to a group health insurance plan or\nemployer based group health plan on behalf of such employees; and\n (c) no benefits are provided under the group health insurance plan or\nemployer based group health plan in excess of the benefits provided to\nthe majority of hospital workers in the community in which the personal\ncare and home health care workers are employed. The commissioner of\nhealth is authorized to add up to fifty-eight million dollars per year\nfor the period January first, two thousand through December\nthirty-first, two thousand two, and up to one hundred sixty-three\nmillion dollars per year for the period January first, two thousand\nthree through June thirtieth, two thousand seven, to rates of payment\nfor qualifying personal care providers and certified home health\nagencies who are approved to participate in the demonstration program.\nThe commissioner may modify the amounts made available for any specific\nannual period so long as the total amount made available for the period\nof the demonstration is not exceeded.\n 3-a. (a) Notwithstanding subdivision three of this section or any\nother contrary provision of law and subject to the availability of\nfederal financial participation, the commissioner of health shall, for\nperiods on and after July first, two thousand seven through March\nthirty-first, two thousand eight, and within amounts appropriated,\nadjust rates of payments for certified home health agencies and\nproviders of personal care services who, (i) are located in a city with\na population of over one million persons, or in a county with a\npopulation of over nine hundred thousand persons if such county is\nlocated within the metropolitan commuter transportation district created\npursuant to section twelve hundred sixty-two of the public authorities\nlaw; and (ii) provide more than fifty percent of their total annual\nhours of home care services to recipients of medical assistance; and\n(iii) contribute, as of July first, two thousand seven, to a group\nhealth insurance plan or employer based group health plan on behalf of\ntheir employees.\n (b) Payments made pursuant to this subdivision to eligible providers\nshall be made proportionally in the form of an add-on to rates of\npayment, based on each eligible provider's most currently available\ntotal annual hours of home care services, as reported to the department,\nprovided to recipients of medical assistance.\n (c) Providers which have their rates of payment adjusted pursuant to\nthis subdivision shall use such funds solely for the purpose of\nsupporting health insurance coverage for their employees and are\nprohibited from using such funds for any other purpose. The commissioner\nof health is authorized to audit such providers for the purpose of\nensuring compliance with the provisions of this paragraph and shall\nrecoup any funds determined to have been used for purposes other than as\nauthorized by this subdivision.\n 4. Notwithstanding any other law, rule or regulation to the contrary,\nany subscriber contract issued by an organization certified pursuant to\narticle forty-four of the public health law may, for purposes of\nimplementation of the demonstration authorized by subdivision three of\nthis section, be issued on an experience rated basis.\n 5. Between January first, two thousand and December thirty-first, two\nthousand two, the state share amount for all demonstrations pursuant to\nthis section shall be no more than twenty-seven million dollars per\ntwelve month period if averaged over the term of the demonstration; and\nbetween January first, two thousand three and June thirtieth, two\nthousand seven, the state share amount for all demonstrations pursuant\nto this section shall be no more than sixty-nine million dollars per\ntwelve month period if averaged over the term of the demonstration and\nbetween July first, two thousand seven and March thirty-first, two\nthousand eight, the state share of medical assistance payments\nauthorized in accordance with subdivision two of this section shall not\nexceed two million eight hundred fifty thousand dollars.\n